Ana’s Story
Ana Gomez Garcia, 71, remembers the night that changed everything. An Argentinian who has lived in the U.S. for 30 years, she began experiencing severe stomach pain before bed. After struggling to fall asleep, she drifted off only to wake abruptly at 2 a.m., unable to speak or use her right hand.
Ana’s husband, Marco, called 911. Paramedics rushed her to Saint John’s Health Center where she underwent a CT scan that confirmed a stroke. Ana was also experiencing bleeding in the brain.
Rushed into surgery, Ana had an external ventricular drain (EVD) inserted in her brain to reduce the pressure from the bleeding. Over the next two weeks, she stabilized at Saint John’s until she was ready for the next step in recovery – inpatient rehabilitation. For that, her physician recommended California Rehabilitation Institute.
Arriving at Cal Rehab
Ana’s stroke left her with significant challenges. Upon arrival at Cal Rehab, Ana couldn’t get out of bed without the help of two people. She developed “Pusher syndrome,” meaning she struggled with balance and an inability to stand and walk. The syndrome caused her to lean and actively push right, because the stroke impacted the left side of Ana’s brain. In addition, the stroke caused aphasia, leaving her unable to speak or understand written and spoken language.
Ana’s main goal was to walk again, an exercise she loved. A long-time childcare worker, Ana also wanted to return to work. Her physician-led team of nurses and physical, occupational and speech therapists developed a treatment plan that would help her reach her goals.
In physical therapy, mirror therapy was used to improve Ana’s sitting and standing balance. Due to her Pusher syndrome, therapists placed a mirror in front of her to improve her midline orientation – the ability to recognize the center of her body. That helped her remain balanced while sitting and standing. She was also able to participate in body weight supported treadmill training which supported her while she practiced walking. Within a few weeks, Ana’s weakened right side was responding to therapy. With improved balance, therapists had Ana use adaptive equipment such as platform walkers and canes, along with an ankle foot orthosis (AFO) and wraps to support her right foot and knee while walking and going up and down stairs.
Ana’s therapists also had her use a functional electrical stimulation (FES) bicycle, which applies low-level electrical impulses to muscles and nerves – making them move. The bike can detect changes in muscle strength and activate a motor to take over as the muscles fatigue. Over time, repeated use of the FES bike encourages the muscles and nerves to function more normally. Ana noted that using the bike could be difficult, “I saw my progress and wanted to keep at it.” Throughout her therapy sessions, Ana would request videos or pictures of herself to monitor her progress and make improvements the next time.
Occupational therapy (OT) also initially focused on addressing Ana's balance so she could complete her self-care tasks. These sessions too included mirror therapy; her functional side was reflected in a mirror while she performed various exercises. Practicing and watching her movements on the non-impacted side helped trick her brain into thinking she was moving the affected side of her body. Building strength and functional movement in her right arm was also woven into OT. Ana used FES and weight-bearing exercises to increase her range of motion and fine motor control. As she built arm strength and coordination, Ana became increasingly independent in her self-care tasks, including dressing and bathing as well as changing positions.
Speech therapists worked with Ana to address her aphasia, which affected her ability to both understand and process information and verbalize her thoughts and ideas. Therapists engaged Ana in consequence-based therapies, which consisted of practicing real life interactions, such as conversation, reading and composing text messages. As Ana’s communication skills improved, therapists incorporated new tactics targeted to improve her cognition, memory, reasoning and visual attention skills.
Daily family visits were also crucial in Ana's recovery. Visiting daily, her family played an integral part in her journey, facing challenges together.
Ana's pivotal recovery moment came when she began walking with a cane. "One day when I was walking with the cane, I was amazed!" she said. The accomplishment boosted her spirits and was a huge nod to the fact that her treatment plan and hard work were paying off.
Results
After nearly six weeks of intensive therapy at California Rehabilitation Institute, Ana had made amazing progress. Not only was she able to walk with a brace and cane but she could independently care for herself with only minor assistance. She had also come a long way in her ability to speak and understand others.
Ana is eager to continue the exercises and walking routines she learned at the Institute. "I want to do the exercises and the walking I’ve been doing in rehab," she said. She intends to build upon her progress with home health therapy.
Ana's experience at the California Rehabilitation Institute was transformative. “I am better because of this hospital.” Her journey sends a powerful message to others facing similar challenges: recovery is possible with determination and support.